American Society of Clinical Oncology Symposium Highlights Quality-of-Care Issues tudies into how quality of care can improve outcomes and overall treatment for patients with cancer were featured during the 2014 American Society of Clinical Oncology Quality Care Symposium, held October 17 through 18, 2014 in Boston. Following are highlights from the research presented.
Parental Status Influences Treatment Decisions Findings from a University of North Carolina pilot study of 42 patients with advanced cancer indicate that parental status plays an important role in treatment decisionmaking. The majority of parents in the study (64%) noted that being a parent motivates them to pursue life-extending treatment to spend more time with their children. Approximately 15% said that preserving parental function was their treatment priority, whereas 12% mentioned the importance of receiving treatment close to their families rather than traveling for a second opinion or having treatment that would require long hospital stays. These concerns will inform future research in this understudied patient population, investigators note. They add that they hope their findings can help oncologists engage their patients who have children in shared decision-making as well as align treatment plans with patients’ priorities.
Weekly Physician Meetings Improve Survival Rates in Some Cancers Results from a population-based study of 5000 patients and 1600 oncologists demonstrated that physician participation in weekly tumor board meetings, a meeting of a multidisciplinary group of physicians to review cancer cases, led to improved survival in patients with stage IV colorectal cancer and stage IV extensive-stage small cell lung cancer. The study, from The University of Texas MD Anderson Cancer Center in Houston, did not demonstrate improved survival rates in other cancer subtypes and stages. In addition, patients whose physicians participated in weekly tumor board meetings were more likely to enroll in clinical trials compared with those whose physicians participated less often. At the same time, patients with early-stage non-small cell lung cancer were more likely to undergo curative surgery. Although the findings are preliminary, the study demonstrates the importance of such meetings and lays the groundwork for future research, investigators note.
Medication Subsidies Improve Adherence to Hormone Therapy Results of a study from the Medical College of Wisconsin of more than 23,000 women indicated that the Medicare Part
D Extra Help program, which includes low-income subsidies for medication, improves adherence to hormone therapy after breast surgery. The results were noted in all racial and ethnic groups, suggesting that the reduction of economic barriers to medication access may help reduce breast cancer outcome disparities, particularly among racial minorities. The study found that in the first year of hormone therapy, overall adherence rates were similar across all races, but racial and ethnic disparities were evident in the subgroup of women who were not enrolled in the Extra Help program. In that group, white women had significantly higher adherence rates compared with black and Hispanic women (62% vs 55%). In all racial and ethnic groups, adherence rates were higher among women who received the low-income subsidy compared with those who did not (71% vs 62% for white women, 67% vs 55% for black women, and 71% vs 55% for Hispanic women.) Although rates of adherence to hormone therapy declined in years 2 and 3, these reductions were smaller among patients using the Extra Help program, a trend that was observed in all groups.
Risk of Death After Surgery for Cancer Reflects Sociodemographic Disparities A study of more than 1.1 million patients who underwent surgery for the most common or deadly cancers found that nearly 1 in 20 patients (5%) died within 1 month of the procedure. The risk of death was highest in patients who were not married, uninsured, nonwhite, male, older, less educated, poorer, or had advanced stage cancer. The researchers, from the Dana-Farber Cancer Institute in Boston, concluded that efforts to reduce sociodemographic disparities in these patients may substantially improve survival. There is no consensus as to why such disparities in this outcome exist, although previous research indicated that 1-month mortality after surgery for cancer is closely linked to hospital and surgeon volume, and these patients are more likely to receive care at lower-volume, underperforming hospitals. Efforts to improve such outcomes may include supporting improvements for underperforming hospitals and proactively offering support services to patients at high risk of poorer outcomes, the researchers say. The study also was the first to demonstrate that these disparities are still highly prevalent among younger populations, because 38.9% of patients evaluated were aged younger than 65 years and not eligible for Medicare. DOI: 10.1002/cncr.29270
© KURHAN, WAVEBREAKMEDIAMICRO, DMITRY NAUMOV / FOTOLIA.COM
S
Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.
Cancer
February 15, 2015
489
Copyright of Cancer (0008543X) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Parental Status Influences Treatment Decisions Findings from a University of North Carolina pilot study of 42 patients with advanced cancer indicate that parental status plays an important role in treatment decisionmaking. The majority of parents in the study (64%) noted that being a parent motivates them to pursue life-extending treatment to spend more time with their children. Approximately 15% said that preserving parental function was their treatment priority, whereas 12% mentioned the importance of receiving treatment close to their families rather than traveling for a second opinion or having treatment that would require long hospital stays. These concerns will inform future research in this understudied patient population, investigators note. They add that they hope their findings can help oncologists engage their patients who have children in shared decision-making as well as align treatment plans with patients’ priorities.
Weekly Physician Meetings Improve Survival Rates in Some Cancers Results from a population-based study of 5000 patients and 1600 oncologists demonstrated that physician participation in weekly tumor board meetings, a meeting of a multidisciplinary group of physicians to review cancer cases, led to improved survival in patients with stage IV colorectal cancer and stage IV extensive-stage small cell lung cancer. The study, from The University of Texas MD Anderson Cancer Center in Houston, did not demonstrate improved survival rates in other cancer subtypes and stages. In addition, patients whose physicians participated in weekly tumor board meetings were more likely to enroll in clinical trials compared with those whose physicians participated less often. At the same time, patients with early-stage non-small cell lung cancer were more likely to undergo curative surgery. Although the findings are preliminary, the study demonstrates the importance of such meetings and lays the groundwork for future research, investigators note.
Medication Subsidies Improve Adherence to Hormone Therapy Results of a study from the Medical College of Wisconsin of more than 23,000 women indicated that the Medicare Part
D Extra Help program, which includes low-income subsidies for medication, improves adherence to hormone therapy after breast surgery. The results were noted in all racial and ethnic groups, suggesting that the reduction of economic barriers to medication access may help reduce breast cancer outcome disparities, particularly among racial minorities. The study found that in the first year of hormone therapy, overall adherence rates were similar across all races, but racial and ethnic disparities were evident in the subgroup of women who were not enrolled in the Extra Help program. In that group, white women had significantly higher adherence rates compared with black and Hispanic women (62% vs 55%). In all racial and ethnic groups, adherence rates were higher among women who received the low-income subsidy compared with those who did not (71% vs 62% for white women, 67% vs 55% for black women, and 71% vs 55% for Hispanic women.) Although rates of adherence to hormone therapy declined in years 2 and 3, these reductions were smaller among patients using the Extra Help program, a trend that was observed in all groups.
Risk of Death After Surgery for Cancer Reflects Sociodemographic Disparities A study of more than 1.1 million patients who underwent surgery for the most common or deadly cancers found that nearly 1 in 20 patients (5%) died within 1 month of the procedure. The risk of death was highest in patients who were not married, uninsured, nonwhite, male, older, less educated, poorer, or had advanced stage cancer. The researchers, from the Dana-Farber Cancer Institute in Boston, concluded that efforts to reduce sociodemographic disparities in these patients may substantially improve survival. There is no consensus as to why such disparities in this outcome exist, although previous research indicated that 1-month mortality after surgery for cancer is closely linked to hospital and surgeon volume, and these patients are more likely to receive care at lower-volume, underperforming hospitals. Efforts to improve such outcomes may include supporting improvements for underperforming hospitals and proactively offering support services to patients at high risk of poorer outcomes, the researchers say. The study also was the first to demonstrate that these disparities are still highly prevalent among younger populations, because 38.9% of patients evaluated were aged younger than 65 years and not eligible for Medicare. DOI: 10.1002/cncr.29270
© KURHAN, WAVEBREAKMEDIAMICRO, DMITRY NAUMOV / FOTOLIA.COM
S
Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.
Cancer
February 15, 2015
489
Copyright of Cancer (0008543X) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
